Movie fans might recognize
Bob Parr as the protagonist of Disney’s hit film, The Incredibles,
who early on in the picture was sued out of the superhero business. He
spends many unhappy years as a civilian until the public realizes they
need superheroes, and he becomes Mr. Incredible again.

Superheroes are not physicians, and physicians are
not superheroes. But you could easily substitute a doctor for the well-intentioned
Mr. Incredible. Physicians
typically go into medicine because they want to help people. Many will also
tell you, however, that in the current litigious climate they often feel
estranged
from their patients, distracted by paperwork, and plagued by red tape and mutual
distrust. When asked to identify the best way to overcome these barriers, both
doctors and patients will say that what they truly desire is an opportunity
to rebuild the trust and mutual concern that are the hallmarks of the
provider-patient
relationship. The University of Miami Leonard M. Miller School of Medicine
has formed the Office of Patient Protection and Risk Prevention to help
achieve that
goal.

he
office’s mission: Put together a team that
will live up to its new name—one that prevents risk, protects patients,
and changes the system for the better of patients and practitioners. “We
feel that as an academic medical center, we can leverage our high-quality
faculty and staff, and our broad academic and scientific resources, to
create programs that not only better manage risk and promote the effective
handling of claims, but also result in better patient outcomes,” says
Steven Stark, executive director of the Office of Patient Protection
and Risk Prevention.

Recent studies have found that one of the most
effective responses to the malpractice crisis is to change the way
doctors communicate
with patients and families. One
of the primary goals of the Office of Patient Protection and Risk Prevention
is to give back control of the relationship to the people who can best maintain
it—the doctor and the patient. “Physicians and patients alike need
to engage in some behavior modification. We need to remember that patients
are our customers and patients need to remember that we are their caregivers.
When
you re-establish that rapport, you have a better chance of enhancing the recovery
of those patients,” says Jorge R. Guerra Jr., M.D., professor of radiology
and chairman of the University of Miami Medical Group Governing Board.

A few years ago the Miller School
of Medicine realized that while the number of malpractice claims had
stayed steady over a
long period of time, the severity
of the claims, jury verdicts, and the cost of settling cases were steadily
and inexorably rising. According to Stark, then an attorney with Fowler
White Burnett,
one of the primary outside counsels for the Miller School, the annual cost
of litigation essentially doubled.

As a result, the school’s administration
commissioned an outside consulting group to study their claims
handling, litigation, and risk management strategies.
At the time, claims against the University were handled through a joint risk
management arrangement with Jackson Memorial Hospital. Although Jackson, a
public hospital owned and controlled by the Public Health Trust,
has sovereign immunity
protection and statutory damage caps for any claims brought by its patients,
it also faced a growing financial crisis. That limited its ability to implement
changes that both UM and Jackson believed were necessary to continue their
academic and public health efforts on behalf of Miami-Dade County.

The Miller School, which had for many years absorbed
a disproportional cost of litigation and medical negligence claims, recommended
that an office be created
to address the claims handling, risk prevention, and patient protection activities
of the school’s faculty practice and the University-owned hospitals. The
new office would work closely with the recently established UM/Jackson Center
for Patient Safety and coordinate the development of additional programs focused
on the needs of its faculty physicians and their patients.

Last fall Stark left his 20-year career with Fowler
White Burnett and joined the Miller School of Medicine to run the new
office. Joining him in this mission
are Farooq Shafi, Keith Lindloff, and Wendy Kverne. Other data management and
analysis staff, litigation management personnel, and people to facilitate provider-patient
interactions will soon be added. Like the faculty and staff of the Center for
Patient Safety, this team is also focused on searching for ways to improve
communication, to enhance systems, and to take whatever steps are necessary
to change the traditional
focus away from simply managing incidents toward a system that works proactively
to prevent them.

In some instances, the change might be a simple one.
In 2002 the hospitals in the University of Michigan Health System began
encouraging doctors to acknowledge
and apologize for their mistakes. They’ve seen malpractice lawsuits and
notices of intent to sue drop significantly.

The risk prevention team at the medical school feels
that simply improving communication could have an impact here as well.

Lindloff, who joined the Miller School in December
after serving as director of risk management for Texas Children’s Hospital, says, “When you
deliver the level of care that gets delivered at the University of Miami/Jackson
Memorial Medical Center—we’re talking about complex cases and a huge
facility—it can be a bewildering place. And people get intimidated by the
size and complexity of what’s going on; they get intimidated and worried
by the fact that they’re sick. As a result, they don’t often ask
questions, they may not know what’s going on, and they may have expectations
that are unrealistic.

“If we can keep them better informed, on the front end or if an event occurs,
we can communicate quickly and candidly with the family afterwards and we might
be able to preserve the relationship,” Lindloff adds. “We then have
a chance, a real good chance, of resolving any issues. We know that there will
always be claims work to do. But we think that we can reduce that amount and
maybe make some of the ones that might otherwise be really, really severe much
less severe.”

There’s already proof that the system can work. In the first six weeks
that Stark was at the Miller School, he and various team members were successful
in preventing at least two cases from going to court by promoting open discussion
and admission of errors where errors had indeed happened. “We try to be
transparent with our disclosure as we talk to patients and families,” Stark
says. “Ultimately, if it’s a case that we believe was the result
of some sort of medical error or medical mishap and that the patients are entitled
to some form of compensation, then we try to do that. We try to sit down with
the patient, tell them we were sorry, explain that we understand what they were
going through, and come to an understanding on reasonable compensation.

“Every medical malpractice case is a story. And professionals need to recognize
that telling the story is an important component of the healing process for our
patients because money does not bring back lost limbs or loss of loved ones,” Stark
adds.

“Our position is that full and open disclosure
is not only already required by AMA guidelines, required by federal law,
required by the Joint Commission
on Accreditation of Health Care Organizations, and now required by state law,
but it is simply the right and ethical thing to do.”

tark and his team want to focus on rebuilding the
relationship between physician and patient, which means not only minimizing
the potential for lawsuits but also
improving systems to reduce errors. “Having represented physicians in civil
actions and before juries and courts, as well as representing physicians before
licensing boards for 20 years, I can assure you that physicians are as affected
emotionally as patients and families are when there are bad outcomes or unanticipated
complications. They all believe that they have not done enough,” Stark
says.

“If we want a system that truly works, then
we need to make sure that there are also systems in place to allow physicians
to do their best to maximize outcomes.
Medicine is extraordinarily complex. To think that a physician or a provider
has to remember every single disease process, have read every single article,
or know all of the new methods or techniques that are available, and then apply
all of that knowledge and a healthy dose of medical judgment to a fairly tense,
often brief interaction with the patient, and come up with the right answer
all the time, is just a denial of the limits of human ability and the
intricacies
of human nature.”

Working with the Center for Patient Safety, facility
risk managers, and clinical investigators, the risk prevention team is
going to spend the next few months
gathering and analyzing all sorts of information, from ergonomics to surgical
procedures, in order to see where and when mishaps occur, as well as track
what Stark calls work-arounds. Once the information is gathered, the
team will identify
trends, assess that information, and go to work on bolstering weak areas.

“Is any of this going to work? I don’t know,” Stark admits. “But
I gave up a 20-year practice because I believe now is the time when we can make
a difference. It’s time to take back control of the most important relationship
in health care, for the profession to step in and say, ‘We understand your
fears, and now we’re going to fix it.’

“We need to put back into medicine what is the most important—the
physician and the patient,” Stark says. Free physicians from the fear,
anger, and frustration that they feel now and they can go back to saving lives.
Just like Mr. Incredible.